During Olympic season, the public watches in awe as talented athletes from around the world compete, secretly waiting to see which ones are going to test positive for steroids. But steroids aren’t the only drug problem plaguing elite athletes. There is growing concern in a number of sports that players are sacrificing their health and their careers to prescription drug addictions.

A Budding Epidemic in Sports

Two of the most commonly abused medications in sports are narcotic painkillers, such as Vicodin and OxyContin, and prescription stimulants, such as Ritalin or Adderall. Prescription painkillers are frequently prescribed (at least initially) for legitimate pain complaints following injuries sustained on the field. Their widespread misuse isn’t surprising given the aggressive nature of sports and the intense pressure on athletes to play injured.

Retired NFL players misuse opioid pain medications at a rate more than four times that of the general population, according to a study from Washington University. More than half (52 percent) of NFL retired players said they used prescription pain medication, 71 percent of whom admitted abusing the drugs during their sports career.

Athletes are drawn to prescription stimulants because they believe the drugs give them a boost of focus and energy. Seeking a competitive edge, some players feign symptoms of attention deficit hyperactivity disorder (ADHD) to get “legal” amphetamines. According to records from Major League Baseball, the number of players getting “therapeutic use exemptions” from baseball’s amphetamines ban quadrupled in recent years. While some players undoubtedly have a legitimate medical need for ADHD medications, it appears that others are merely looking for ways to evade the amphetamine ban.

A Set-Up for Addiction?

Being a professional athlete may seem like a dream job, but intensive training and pressures to perform can have unexpected side effects, including an increased risk of addiction and other mental health issues. Why the association between sports and drug addiction?

Theories abound, but a growing body of research shows that exercise can stimulate the dopamine reward system in the brain much like drugs of abuse. While most of us could use more exercise in our lives, elite athletes may develop a compulsive preoccupation with training that resembles addiction. A study published in the Journal of Sports Sciences, which tracked competitive runners in the U.S. and triathletes in Hong Kong, found more than half had compulsive-exercise tendencies. As Texas Rangers outfielder Josh Hamilton described it when he was sidelined with a back injury, “alcohol and drugs were the closest thing I could find to getting that feeling when I was playing the game.”

The heavy physical training elite athletes endure may prime the brain for addiction. According to a study from Tufts University, an extreme preoccupation with training can mimic the biological effects of drug abuse, leading to withdrawal-like symptoms such as anxiety and depression when the exercise stops. Exercise releases the body’s natural opioids, endorphins, and has long been touted for relief of stress, anxiety and depression. These findings could help explain why athletes often struggle with substance abuse, especially once they leave their sport.

In addition to the biological components, athletes face extreme pressure to impress coaches and please adoring fans, which may contribute to drug and alcohol abuse, eating disorders and other mental health issues. Exhaustion from training and competing has also led to symptoms of depression and anxiety in some athletes.

Self-Medicating Pain and Loss

When athletes get injured or retire, they may feel torn about losing their place in the spotlight. The let-down many athletes experience can bring on unexpected mental health issues. Several beloved athletes have come forward with their struggles, including:

• Seven-time Olympic medalist and former world record holder Amanda Beard, whose swimming career was marked by depression, bulimia and substance abuse.

• Eight-time world record holder Geoff Huegill battled drug abuse, dramatic weight gain and depression following his retirement from swimming after the 2004 Olympics.

• After spending a season on injured reserve, Tennessee Titans wide receiver O.J. Murdock died of what appeared to be a self-inflicted gunshot wound.

For athletes, the perks of the job may actually contribute to the problem. Many have the means to fund hefty drug habits, yet exhaust all of their resources by the time they realize they need treatment. Since their family, friends, coaches, the public and even law enforcement want to see them continue playing, many are shielded from the negative consequences of their addiction.

Inside reports suggest that the professional sports culture may encourage and even facilitate drug dependency among players, making addictive medications easily accessible and taking whatever measures necessary to keep the players on the field. As awareness has grown about the epidemic of prescription drug addiction, sports organizations are tightening the reigns but problems remain:

• Former New York Jets backup quarterback Erik Ainge missed the entire 2010 season because of an addiction to painkillers following a football injury.

• Randy Grimes, former lineman for the Tampa Bay Buccaneers, came forward in 2009 to talk about his addiction to prescription painkillers.

• Former NBA player Chris Herren gave up his career to a 14-year drug addiction.

• Last year, hockey player Derek Boogaard died at age 28 of a drug overdose while recovering from a concussion.

• In 2009, former Philadelphia Eagles defensive tackle Sam Rayburn was arrested for attempting to obtain a controlled substance by forgery or fraud to fuel a prescription painkiller addiction that at its peak involved consuming more than 100 Percocets a day.

The tragic stories, too numerous to mention, highlight the harsh realities behind the glamorous image of sports stardom. At the same time the medical community at large is trying to distinguish legitimate from illegitimate needs for prescription medication, sports doctors and team managers must strike this same balance or risk having their best players sidelined by addiction.

David Sack, M.D., is board certified in addiction psychiatry and addiction medicine. Dr. Sack served as a senior clinical scientist at the National Institute of Mental Health (NIMH) where his research interests included affective disorders, seasonal and circadian rhythms, and neuroendocrinology. He currently serves as CEO of Elements Behavioral Health, a network of addiction treatment centers that includes Promises in California, The Ranch in Tennessee, The Recovery Place in Florida, and Right Step and Spirit Lodge drug rehabs in Texas.